November 7, 2008
Cleveland_Clinic_Host: Welcome to today’s live health chat with Dr. Holly Thacker. Dr Thacker, a trailblazer in women's health, founded the interdisciplinary Center for Specialized Women's Health Cleveland Clinic and also founded one of the first women's health fellowships in the United States. Her interests include menopause and hormone-therapy regimens, osteoporosis, and the use of hormone therapy by breast-cancer survivors.
She has served as a co-investigator of various hormone-therapy-system regimens as well as osteoporosis therapeutic drug trials and is regarded as a national thought leader in women's health. She has published and lectured extensively on the topic of menopause and is a NAMS-credentialed Menopause Clinician. Dr. Thacker is also the author of Women's Health: Your Body, Your Hormones, Your Choices - a Cleveland Clinic Guide and the upcoming book to be published in 2009 by Kaplan Cleveland Clinic Guide to Menopause.
Dr. Thacker, thank you for joining us today to answer questions. We'd also like to thank Upsher-Smith Women's Health for sponsoring today's chat.
During this next hour, we hope that this chat will increase awareness of women’s health and the importance of understanding our bodies as women. Let’s begin with some general questions about women’s health and the effects of aging. The big concerns are how can a woman age gracefully while searching to understand hormonal changes, menopause, bone health, heart disease, cancer, sex and nutritional needs? Much of the information that explains what is happening is often confusing and contradictory. We hope that many of the online questions today will help explore these topics further.
scarychick: How do I know if/when I’m going through menopause? Does age factor in, meaning the younger or older you are, there may be a difference in symptoms?
Speaker_-_Dr__Holly_Thacker: You know you are beginning menopause when you either experience a change in your menstrual pattern or stop having menses. The average age for menopause is 51 years. You may follow the age of menopause when your mother began menopause. Symptoms are not necessarily related to age, but are most intense when the periods stop and for 2 years after the periods stop.
abc123: Is it normal for my periods to be getting heavier and heavier as I age? Is there anything that can be done about increasingly heavy periods?
Speaker_-_Dr__Holly_Thacker: No, not necessarily. If you have heavy periods, it could reflect hormone imbalance, fibroids, infection and even potentially cancer. Yes, there are many things that can be done to decrease heavy periods such as specific targeted fibroid therapy, endometrial ablation, hormonal medicine therapy and placement of the therapy Mirena uterine system. Rarely is a hysterectomy needed.
gettingthere: For women & menopause is it better to see a GYN or a family doctor?
Speaker_-_Dr__Holly_Thacker: It depends on what that physician's practice interests are. Many otherwise good doctors do not have any interest or expertise in menopause. I'd recommend checking the www.menopause.org site for physicians in your area who are credentialed menopause practitioners.
newtonm: What treatments work for hot flashes?
Speaker_-_Dr__Holly_Thacker: Estrogen or hormone therapy is the best treatment for hot flashes.
katydidit: Is hormone replacement therapy (HRT) always necessary?
Speaker_-_Dr__Holly_Thacker: No - if you are doing well and not having symptoms of menopause then, hormone therapy may not be necessary. But if you are low on hormones and having symptoms, this needs to be evaluated and individually treated. We have several different options including some low dose estrogen gels.
We have bioidentical transdermal and vaginal therapies. One of the newest options is a transdermal estrogen gel, called divigel that comes in 3 different doses and are conveniently wrapped in small foil individual dose packs to apply to the skin
justcanttakeit: Does HRT help with memory loss and or fatigue?
Speaker_-_Dr__Holly_Thacker: Yes - if the symptoms are caused by low estrogen and or hot flashes. Details of all the hormonal therapies are noted in my upcoming book to be published 2009. The name of the book is "A Cleveland Clinic Guide to Menopause" and will be published by Kaplan Publishing.
mommyplease: Do you feel Evista is as effective as Premarin and Progesterone?
Speaker_-_Dr__Holly_Thacker: No - not for hot flashes. However, if you do not have hot flashes and are at high risk for breast cancer and/or osteoporosis, and not at risk for blood clot, then you may want to discuss the use of Evista (raloxifen) with your physician.
caspar123: Has a study been done to see if natural progesterone is effective?
Speaker_-_Dr__Holly_Thacker: Natural oral micronized progesterone in the form of Prometrium does protect the endometrium which is the lining of the uterus and as been studied. However, the transdermal progesterone creams do not reach significant blood levels to reliably protect the uterus. So in general, they are not clinically recommended. Furthermore, progesterone alone does not protect against osteoporosis or effectively treat hot flashes.
hotandcold: Are there any alternates to estrogen?
Speaker_-_Dr__Holly_Thacker: Yes there are alternatives to estrogen. For women with hot flashes who cannot or will not take estrogen, there are some alternatives called NSRI's like Effexor or Pristiq. These are prescriptions. They are not specifically FDA approved to treat menopausal symptoms, but we use them off label. Other treatments options are also mentioned in my book "Your Body, Your Hormones, Your Choices" which can be downloaded on line or ordered at Amazon.
playingitsafe: Are there any new contraceptive options on the market?
Speaker_-_Dr__Holly_Thacker: One of the newest options is the implantable Implanon which lasts 3 years.
The biggest change in contraception has been using extended regimens so that menses are not required. The Mirena IUS lasts for 3 years and can be used even in women who have not had children.
newtonm: Does Premarin help with hair loss?
Speaker_-_Dr__Holly_Thacker: Many times, estrogen therapy does help both the skin and the hair.
Estrogen and Breast Cancer
tiredmom: Is there an estrogen replacement that can be taken if you have breast cancer? What problems are associated with this replacement?
Speaker_-_Dr__Holly_Thacker: In general, most doctors do not prescribe estrogen to women who have had estrogen sensitive cancers such as breast cancer. However, in women with severe menopausal symptoms, particularly if they had estrogen receptor negative breast cancer, this can be considered.
Furthermore, most all breast cancer survivors can receive local vaginal estrogen, such as in the form of estring-which is a very low dose, local estrogen that affects the vaginal tissues without any significant systemic effect.
stillawoman: Is it normal for a woman’s sex drive to evaporate over time?
Speaker_-_Dr__Holly_Thacker: Female sexual desire is complicated and affected by many things. It is normal for women who have moved past the reproductive phase to notice a diminished sex drive. Many normal women do not report spontaneous sex drive but enjoy sexual activity and are sexually active for other reasons than having simply the drive to seek out sexual activity. The best aphrodisiac is a respectful, loving partner. Medically, we are concerned about sex drive if the person is distressed, if sexual activity is painful, and/or if there has been an abrupt change in sexual function.
Osteoporosis and Menopause
fedupwithit: How do I know if I’m developing osteoporosis?
Speaker_-_Dr__Holly_Thacker: Within 2 years of menopause, it is a good idea to talk to your physician about getting a bone density test. This test is a simple, painless scan that determines bone mineral density. Unfortunately, the vast majority of women after menopause, begin rapid bone loss and this usually occurs without any symptoms
fedupwithit: What can I do to maintain my bone health?
Speaker_-_Dr__Holly_Thacker: All persons should ingest enough calcium AND vitamin D3-at least 1,000 IU daily. Just taking Calcium with Vitamin D supplement together many times is NOT enough vitamin D. Regular weight bearing exercise is also vitally important for bone health.
However, you can exercise and drink milk and take your supplements and still lose bone if you are estrogen deficient so it is important to monitor bone health with periodic bone densities and hormone assessment for the postmenopausal woman.
The Benefits of Soy Protein
catsmeow: What are your thoughts on soy protein supplements on a daily basis for women 40 and over?
Speaker_-_Dr__Holly_Thacker: I do NOT recommend soy pills or supplements; HOWEVER, I think substituting some soy foods in place of animal protein is a good idea-especially as this many help lower cholesterol levels in some women. However, high dose soy pills or powders are not recommended as they can increase the risk of uterine hyperplasia and even cancer. Some women get health benefits with soy foodstuffs but many women can not convert soy into equol-a weak estrogen.
For any woman adding soy foods to her diet, she needs to SUBSTITUTE it for other foods and NOT ADD it alone as this will just be adding calories which can lead to weight gain.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Thacker is now over. Thank you again Dr. Thacker, for taking the time to answer our questions today. We would also like extend our appreciation to Upsher-Smith Women's Health for helping sponsor today's chat.
Speaker_-_Dr__Holly_Thacker: Thank you very much for inviting me to this forum.
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